At a time when overdose deaths reach a record high in the province, the third and final part of this series explores how adverse childhood experiences can lead to substance use, and what can be done to prevent it.
The question of whether the emotional stress caused by COVID-19 will have a long-term psychological effect on British Columbians isn’t a matter of if – it’s a matter of just how widespread it will be, says a leading physician in the province.
South Surrey’s Dr. Tahmeena Ali, who this year was named the BC Family Physician of the Year, and White Rock psychologist Jennifer Mervyn, who was among 150 Canadians recognized as a leader in mental health, have both signed an open letter urging government to prepare for the potential short- and long-term harm from the ongoing COVID-19 pandemic.
Mervyn and Ali are joined by more than 200 child advocates, physicians, researchers and health care professionals in the province who’ve signed the ‘Urgent Action for Kids in the Covid-19 Pandemic Recovery’ letter.
“Children’s social environments have shrunk during the isolation measures, diminishing critical opportunities for co-regulation of emotion and stress through social connection and the support of broader families, communities, and culture,” the letter reads.
The letter asks that a B.C. task force be created to support an evidence-based strategy for children’s wellness during pandemic recovery.
“This is potentially creating trauma for people, this COVID situation,” Mervyn said. “We don’t have as many people to bounce things off of, to regulate, to get away from the stress, to talk through things with. That’s so critical, to us as human beings, it actually changes how our brains work.”
A comprehensive study by U.S. organization Kaiser Permanente published in 1998 examined the link between adverse childhood experiences (ACEs) and challenges in adulthood. The study found the more adverse experiences a child has endured in their life, the more likely they are to have health complications, including diabetes, high blood pressure, and substance abuse.
Ali said trauma doesn’t need to be overt. It can be the result of something as simple as a workaholic parent, who loved and provided for their child, but never developed an emotional connection with them.
“That leads them down a road that isn’t as healthy in terms of self-coping mechanisms,” Ali said.
In June, B.C. recorded 175 overdose deaths, the highest monthly total for the second consecutive month. The drug overdose crisis, experts have said, has been exacerbated by COVID-19.
“COVID just illustrates the vulnerabilities in society that when any of us are under stress, our coping mechanisms are where we go to. So whether that’s getting violent, or losing our temper, or overeating, or using drugs. It’s not a surprise, to any of us, that the overdose deaths are up. It’s a sad reality that when we have dysfunctional coping mechanisms, that’s what we fall on in periods of stress,” Ali said.
Preventing drug overdoses through harm reduction practices, such as safe injection sites and distribution of naloxone, has resulted in fewer overdose deaths. But some experts describe harm reduction as a Band-Aid solution to a bigger objective, which is providing citizens with the tools they need to not rely on drugs as a self-soothing mechanism in the first place.
Both Ali and Mervyn agree that the most important thing people need, whether or not they experienced ACEs, is to have connected relationships. Mervyn described relationships as a way to co-regulate stressful environments, and Ali said it’s critical for a young child to have at least one connected relationship with an adult.
“When you’re wrapped around love and support and care and connected relationships that help you co-regulate, and bring your stress levels down and know that you’re safe and protected,” Mervyn said. “Toxic stress is when we’re experiencing these stressful environments in our day-to-day environment in the absence of that support.”
Both women said the medical field is in the early phases of applying ACEs research and working from a trauma-informed approach. However, there is a long way to go.
“It’s also a cultural of medicine all around us that has to start shifting to that trauma-informed approach of recognizing that our tone of voice, and how we question patients, and how we approach them universally needs to shift. So that people don’t feel ostracized when they come into emergency intoxicated with alcohol yet again, but they feel supported and understood that this is a disease that comes from other things,” Ali said.
However, a change towards a trauma-informed society doesn’t start or end with the medical community.
Mervyn suggested that prenatal classes could be re-tooled to teach young parents how to establish meaningful connections with a newborn, ACEs, early brain development, stress management, and a way to break generational trauma.
Sources manager of substance use services George Passmore said a prenatal program of that nature would be the “ultimate dream.”
Over the course of this series, Peace Arch News has interviewed health and addictions experts, an active substance user, people who are in recovery and a man who lost a child due to overdose. Everyone that PAN spoke to agreed that decimalization of drugs would be an effective tool to save lives.
Recently, the Canadian Association of Chiefs of Police president, Vancouver police Chief Adam Palmer, called for the decriminalization of simple possession of illicit drugs. B.C. Premier John Horgan put his support behind the call, as did provincial health officer Dr. Bonnie Henry, adding “there’s no more important time for us to do this than now.”
“We need to put as much time and effort and kindness and compassion into caring for people who use drugs as we have been successful in doing in responding to the COVID-19 crisis,” Henry said at one of her near-daily July COVID-19 briefings.
The ‘Portugal Model’ is often touted for its success for decriminalizing drugs and turning substance misuse into a health issue, not a criminal one. In the 1990s, Portugal was averaging 360 drug overdoses per year (in comparison, B.C. has half the population of Portugal and recorded 728 overdose deaths so far in 2020).
After Portugal decriminalized drugs, the overdose deaths dropped to 26 in 2016. The number of heroin users in that country dropped from more than 100,000 when they created the policy in 2001 to less than 25,000 in 2017, according to the country’s health ministry.
Portugal paired decriminalization with a rehabilitation program and safe drug supply. People caught with a personal-supply of drugs in the country are not put in the criminal justice system, but instead are encouraged into treatment programs that are immediately available and fully subsidized.
“This is a very difficult conversation to have, and it’s understandable,” Passmore said. “I struggle with some of the implications of the ideas around fixed drug supply. I struggle with it, and yet, when I look at what’s happening, I think, let’s stop empowering the organized crime.”
White Rock’s Ryan Nielsen, 26, who’s recovered from a six-year heroin addiction, said the most effective way to save lives is to provide a safe drug supply.
“Of course that’s a very tricky slope. We can do the whole counselling or whatever there is, but there are addicts that maybe won’t want to do those steps. If you actually add a safe drug supply that would save a lot of lives,” he said. “I know a lot of people don’t like that idea. It would immediately save lives.”
White Rock Mayor Darryl Walker agreed in that drug use is a health-related issue, not one of criminality. However, Walker said people who sell illicit drugs need to be held accountable.
“Decriminalization speaks to a level of control where people can get it and they don’t have to worry about getting it through somebody who’s a pusher, trafficker, or whatever. Where they can actually get it safely. We need to talk about it as a health-related issue. We’ve gotten partway there with marijuana,” Walker said.
It’s discussion, he added, that needs to involve the whole community.
“And we have to do it under a guise of health-care as far as I’m concerned, because that’s what it is,” Walker said.
Ali said the issue with policing personal drug use is that it doesn’t resolve the root cause of why people to pick up substances.
“So putting them in jail or fining them isn’t going to fix the hurt inside that they’re trying to heal,” Ali said.